Op-Ed: Will the VA's Transformation End Before it Really Begins?

In this photo taken April 27, 2017, Veterans Affairs Secretary David Shulkin is seen at the Veterans Affairs Department in Washington. (AP Photo/Andrew Harnik)
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Military.com|By
Suvas Vajracharya

Suvas Vajracharya, Ph.D., is founder and CEO of Lightning Bolt Solutions, which automatically generates 3 million hours of AI-optimized physician shift schedules for hospitals each month. Prior to founding the company, he worked as a staff scientist at the Los Alamos National Labs, scheduling massively parallel supercomputers.

David Shulkin, MD, has been a transformative force within the U.S. Department of Veterans Affairs (VA) during his two-year tenure. But now there are rumors in The Washington Post that he interviewed for Tom Price's former Secretary of Health and Human Services role.

Shulkin brings what The New York Times calls a "tireless focus on efficiency" from his private sector career in healthcare management. At the VA, Shulkin has already made waves by setting up online appointment booking for patients, releasing data around patient wait times, and shifting to a surprising electronic health record (EHR) vendor.

He has developed a reputation for making change happen and cutting through bureaucracy. As undersecretary, when his staff said it would take almost a year to plan an event to discuss veteran suicides, Dr. Shulkin said the delay would cost 6,000 veteran lives and successfully pushed to hold the summit in a month instead.

This possible exit comes just as the VA is about to roll out its master plan for ensuring every veteran has access to timely, quality care -- and at a time when the healthcare sector has just started to see the results of what Shulkin's focus on efficiency and technology could deliver.

The VA is roughly the same size as Kaiser Permanente, but easily lags a decade behind the HMO. Where Kaiser manages a physician-to-patient ratio of 554 to 1 -- one doctor for every 554 patients -- the VA is 55% behind at just 356 to 1. Kaiser transformed this metric over a decade through a focus on better matching of projected patient volumes with provider capacities, telemedicine, use of mid-levels, and smarter physician shift scheduling -- the kinds of transformations Shulkin is known for.

If the VA could match Kaiser's physician-to-patient ratio (an initiative which I'm sure Shulkin would be capable of leading), the department would save $1.6 billion a year.

Those savings could be applied to increase VA physician salaries to Kaiser levels -- currently, the VA pays 21% less to primary care physicians and 55% less to surgeons on average -- which, in turn, would help combat the VA's physician turnover issue, which is 4x higher than at Kaiser.

And the VA would still save $427 million a year after these raises. (If this research interests you, there's an 11-page report to download comparing the VA and Kaiser in detail.)

Imagine the technology investments Shulkin could make with these millions in savings. He could restore the department's leadership in health technology and deliver the quality care our nation's veterans deserve. Hopefully, he'll stick around to see the dream of an efficient, high-tech VA come to fruition.

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